Managing a Manic-Depressive

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My board members thought that Dan Richards was an odd choice to head up strategic planning at the Knoxville Company. They liked their executives weathered, and Dan looked like he’d stepped out of a teen movie. At 35, his manner was disarmingly boyish, or annoyingly so, depending on whom you talked to. Still, everyone agreed that his credentials were excellent: two master’s degrees from the London School of Economics and stellar recommendations from three top executives. And he had spent seven years reorganizing distribution at our top competitor in Europe.

During my ten years as CEO, the Knoxville Company had grown from a $1 billion to a $4 billion retail electronics business. A year before I arrived, however, the company had begun manufacturing its own products, mostly TVs and sound systems, to sell in our 2,500 retail stores. It was a great idea that had produced dismal results. In the last three years, profits had dropped, stock prices languished, and sales stagnated. The company needed a radical change, and I thought that Dan might give us a jolt.

He arrived at headquarters in early June and wasted no time getting settled. His job was to restructure the company’s 3,000-employee manufacturing division, which would inevitably mean job losses at every level. Even among the corporate staff, morale was low. While his predecessor had been staid and remote, Dan breezed in like a populist politician. He visited every department and stopped by offices just to talk, joke, or elicit suggestions for improving manufacturing. His charm was infectious, and morale improved in a matter of months.

Dan’s work habits were striking, even to a fellow workaholic. By 6:00 a.m., he was at his desk; he rarely left the office before 8:30 p.m. He boasted that he never slept more than four hours a night. When he was excited about a project, his mind seemed to race. He threw out new ideas before I’d had time to absorb his previous ones. Within three months of his arrival, he had rejected just about all our proposals for restructuring the division and had come up with a radical new plan to sell off manufacturing and focus on what we do best: retailing. I was startled at first and even a bit angered by his brashness. But the more I thought about it, the more I bought in.

Dan and I handled the sales negotiations together. He got a real charge out of the endless meetings with corporate honchos and investment bankers. Our investors were thrilled that we were going to be focusing on sales again; so were the analysts. Dan had his five minutes of fame in the press, and he relished the attention. When the attention died down, however, so did he.

I first noticed the change in Dan about six months after he arrived at Knoxville, when he began coming in at 9:00 a.m.

“Helen’s on me to spend more time with the kids,” he told me one morning, although I hadn’t asked.

The following day I stopped by his office to find him asleep at his desk—odd behavior for a man who usually ran on four hours a night.

Dan started falling asleep at his desk—odd behavior for a man who usually ran on four hours a night.

It was at a company meeting three weeks later that I became concerned. Dan had a way of using humor to point out a flaw in someone’s argument without offending. Now I noticed an edginess about him. When he thought an idea was stupid, his face registered disgust. His typically wry comments turned nasty. At first I thought it was the lack of sleep catching up with him, but the behavior only worsened in the coming weeks. During a particularly tense discussion about budgets, Dan got up and left, as if we were all too ridiculous to be taken seriously. Pretty soon, even his friends were having a field day discussing him behind his back.

If he had been a difficult character, I might have understood, but Dan had been almost too conciliatory with other employees during his brief tenure. He so desperately wanted to be liked that he had gone a little overboard to please. Now he was acting like an arrogant kid, alienating the people who had backed him and embarrassing me. I approached Dan’s secretary one morning to see if she could help me gain some insight into his erratic behavior, but she treated me like an IRS auditor. She hadn’t noticed any change in Dan, she said.

I realized that I would have to talk to Dan directly. By this time, he was something of a friend as well as a colleague. But when I stopped by to see him that afternoon, it was like talking to a different person. He was bleary-eyed and exhausted. His suit, usually immaculately pressed, looked as if it had been slept in.

“I know I haven’t been myself lately,” he told me. “My father has been sick.”

“Why don’t you take a couple of days off and go down and see him?” I suggested.

“No, I need to keep working,” he said, with an urgency that surprised me. “It takes my mind off things.”

Dan seemed to rally for a couple of weeks, and I was glad to have some semblance of my young friend back. But his efforts at camaraderie felt strained. He was no longer rude at meetings, but he was easily distracted during negotiations. We were close to finding a buyer, and I needed Dan in top form. But by mid-February, he looked worse. He was calling in sick every few days and keeping his office door closed. It was amazing to see how a change in one person could affect an entire division. The whole place seemed a little duller, grayer, as if Dan’s mood were catching. I started to wonder how long a division could run with a no-show boss. Rumors about the impending sale were flying, and Dan wasn’t around to respond.

Finally, I called Dan’s wife, Helen, who sounded as worn-out as her husband. She repeated the sick father story, which I had never believed. I suspected that all of Dan’s relatives knew the story by heart.

By now, Dan had been out of sorts for a month and a half. I suppose I could have gone to our Employee Assistance people, but I wanted to keep this matter private. Instead, I went to Dan’s office to insist that he take a week off. This time the door was open, and Dan was staring into space. He looked as if he’d aged ten years. Smiling weakly, he motioned to me to sit down. There was an awkward silence until he held up his arm as if to show me a bruise.

“Have you ever felt as if you had no skin?” he asked.

“What do you mean?” I said.

“Have you ever felt as if every single one of your nerve endings were exposed and even the slightest touch could hurt you?”

When I didn’t answer, Dan smiled condescendingly.

“No, I didn’t think you did. It’s OK. I know I need some time off.”

When Helen called to tell me that Dan had checked himself into a mental hospital, I berated myself for not having read the signs sooner. I knew enough about depression to realize that he needed more than a day in the country. Helen assured me that Dan was in an excellent facility with a first-rate doctor, who prescribed an antidepressant and lithium to stabilize his moods. Apparently, his chemistry was such that his moods swung from too high to too low. His highs were not that high, but his lows were brutal. The medication, they hoped, would even him out.

Dan’s highs were not that high, but his lows were brutal.

“If you’re going to have a mental illness, they say that bipolar illness is the easiest one to treat,” Helen told me with a forced cheerfulness. “That’s what they call manic depression now. The doctor thinks he’ll be back at work in a month.”

My attempts at reassurance were pitiful. I didn’t know what to say. Helen talked about manic depression as if it were a case of nerves. But I knew something about mental illness. I had a second cousin who spent half her life in hospitals and the other half racing around town like a lunatic. During one of her manic periods, she racked up a $13,000 department store bill in a single day. I could not imagine Dan going off the deep end, but then I never would have pictured him stuck in a hospital with depression. The whole situation was beginning to depress me. God knows, I’ve had my own share of moods, but I’ve always made sure to keep my emotions in check on the job.

I wanted to let Helen know that I cared about Dan, but I also had to think about whether or not letting him come back would be good for the company. On the one hand, I couldn’t imagine the company without Dan. He had been one of our most productive workers. The cost of replacing him would be considerable. And where would we find someone with his talent?

On the other hand, the man I had seen slumped over his desk was in no shape to oversee a major sale. How did I know that he would ever be the man I’d hired? Why didn’t he say anything before I hired him? Even if he seemed fine in six weeks, how did I know he wouldn’t crash again, taking the division along with him? And what if he went on a manic spree with company money?

Maybe the pressure of running a large division was just too much for him. And how would employees feel about a boss who had spent a month in a mental hospital? This wasn’t some East Coast ad agency that was used to this sort of thing. Already I’d heard some talk about Dan’s breakdown. The word alone was enough to make me cringe.

Should the CEO allow Dan to return to work?

Dr. Jeffrey Lynn Speller has consulted with bipolar executives and his families for more than a decade. Speller is the author of Executives in Crisis: Recognizing and Managing the Alcoholic, Drug-Addicted or Mentally Ill Executive (Jossey-Bass, 1989).

Dr. Tanya Korkosz has consulted with bipolar executives and their families for more than a decade. Korkosz and Speller are currently cowriting Soar with the Eagles: A Guide to Harnessing the Power of the Bipolar Executive.

Manic-depressive executives like Dan, when psychologically stable, are often brilliant performers. Dan’s energy, creative problem-solving ability, and focused intensity were clearly assets to the company. In our consulting experience during the last decade, we have found manic-depressive executives at the top of some of the most successful U.S. companies as chairmen, CEOs, and senior VPs. They are well represented among the ranks of the United States’s most brilliant entrepreneurs. They are risk takers. They build empires. And they often become very wealthy. High political office has always attracted its share of manic-depressive leaders, including Winston Churchill, Theodore Roosevelt, and Abraham Lincoln.

The problem is, of course, that undiagnosed and untreated manic-depressive executives, like Dan, often exhibit unpredictable mood swings between periods of intense energy and great productivity and periods of immobilizing depressions.

How many manic-depressive executives are there in the United States? Although the number has been estimated at 1%—or between 2 million and 3 million manic-depressive Americans—no reliable data exist regarding how many of these individuals can be found in the work-place, much less in the corporate suite. From our experience working with several hundred bipolar executives, we estimate that as many as 5% to 10% of corporate America’s senior executives may be manic-depressive, with more than 90% going undiagnosed and untreated.

Fortunately, Dan appears to have a milder form of the manic-depressive illness called bipolar II disorder or bipolar disorder NOS, the most common form of manic-depressive illness found in corporate executives. Bipolar II executives rarely, if ever, progress to the much more serious “out-of-touch-with-reality” manic-depressives like the CEO’s second cousin, who spent a good deal of her life in hospitals and, most likely, suffered from hallucinations. In our experience, we have found that bipolar II corporate executives outnumber executives with the more serious variety of manic-depressive illness by about ten to one. But even a bipolar executive with more severe symptoms may function well with the right treatment.

Unfortunately, the major barrier to the early detection and proper treatment of bipolar II executives like Dan is the stigma associated with the illness. One executive VP of a Fortune “100” high-technology company was so worried about the stigma that he went to great lengths to keep colleagues from finding out about his manic depression. When he was admitted for two weeks to the psychiatric unit of a general medical hospital for depression, he told his colleagues that he was having back surgery. He refused to allow anyone from work to visit him; and he paid his $10,000 hospital tab out of his personal funds rather than use his insurance, which would have covered 80% of the cost.

How could this situation have been handled better by both Dan and the CEO? First, Dan should have been more proactive in seeking help and advice about his condition. More specifically, he should have sought a confidential evaluation by a mental health professional. The earlier the detection of psychological difficulty by a competent mental health professional, the easier it is to intervene and reverse the process—in many cases, without the need for hospitalization.

In this case, Dan did not appear willing, or able, to take corrective action early on. The responsibility then fell to the CEO to step in when he noticed Dan asleep in his office; he should not have waited another three to four weeks. Instead of enlisting Dan’s secretary for her views on Dan’s erratic behavior, the CEO should have convened a meeting of the corporate director of the Employee Assistance Program (EAP), the corporate medical director, and the corporate director of human resources. In the meeting, the CEO should have confidentially offered his observations of Dan’s behavior and requested impartial perspective, commentary, and advice. If the individuals at the meeting agreed that Dan did indeed appear to be developing a serious psychological problem, the CEO and one or both of the other parties would meet with Dan. They would then inform him that he would be required to undergo a psychological evaluation by an outside mental health professional to determine his continued fitness to perform his job. And they would emphasize the confidential nature of that evaluation.

An outside mental health consultant would then perform the evaluation and report back to the CEO through the corporate director of human resources. In Dan’s case, the consultant would confirm that he did indeed have a serious problem affecting his fitness to perform his job and that he most likely needed hospitalization. Neither the diagnosis nor the detailed nature of Dan’s problem would be disclosed to any third party.

Dan’s eventual return to his job after hospitalization would be facilitated by the outside mental health consultant, who would review Dan’s records, converse with Dan’s hospital psychiatrist, and examine Dan again posthospitalization. The mental health consultant would present his or her findings to the corporate director of human resources, the corporate director of EAP, the corporate medical director, and the CEO. Together, they would decide whether or not Dan’s job needed to be restructured. Dan would also be given time to pursue any outpatient treatment in counseling during the last stage of recovery. The high-stress, tense negotiating sessions and tight timetables of Dan’s job are not well suited to his ongoing recovery, and the CEO would most likely have to relieve him of those responsibilities for a period of time.

Drugs such as lithium allow properly diagnosed and treated bipolar executives like Dan to maintain their mental equilibrium.

The good news is that recent advances with drugs such as lithium and Tegretol now enable properly diagnosed and treated bipolar II executives, like Dan, to maintain their mental equilibrium and productivity, often entirely avoiding the problem of future depressive episodes. Admittedly, it will take time for Dan to get back on his feet emotionally. However, if he is like many of the bipolar II executives we have counseled over the years, he will bounce back stronger than ever with the ongoing support that medication and competent outpatient counseling can provide.

Veteran journalist Mike Wallace is a correspondent on 60 Minutes.

If Dan is lucky, it will take him a couple of months to recover from his depression. If he’s less lucky, it could take five or six months. You cannot put your stockholders at risk for such a long time. I’m not suggesting that the CEO fire Dan. Intelligent management would say this guy is too good to lose. I recommend putting a new person in his place temporarily and giving Dan a less pressured job while he recovers. In three to six months, give him back his old job.

Intelligent management would consider Dan too good to lose.

I, too, suffered from depression. Mine was not bipolar. It was just old-fashioned clinical depression, and it played hell with my body and my psyche. You really do feel your nerve endings. I used to get shooting pains up and down my arms. And I’ve never felt so vulnerable. Those are classic symptoms of depression, and you don’t want a person in that state managing a company.

When my depression hit in 1984, I was involved in a libel trial between General William Westmoreland and CBS. I had to be at the trial every day, and I was responsible for managing a team of about 15 people. Like Dan, I was in no shape to handle the responsibility. When you’re in that state, you can’t concentrate, you don’t remember, you are indecisive, and your self-esteem is very low. You believe yourself to be a fraud and a fake. I didn’t recognize the depression for what it was, and neither did my general practitioner. As a result, I wound up in the hospital for ten days and began to get pharmacological and psychiatric help. Had CBS told me to retire early or go to the beach, I would have been devastated. Fortunately, my boss knew that I would eventually recover and do the kind of work that I had been doing before.

Recently, a producer on my team came down with depression, and senior management also backed him throughout his recovery. While he was in the hospital, the company kept paying him—and, remember, this is a tight-fisted company—without pressuring him to come back. When his contract came up for renewal, management didn’t say yes or no. They just waited it out. It was clearly the right move, and one Dan’s boss should consider. Four months later, the producer was back and doing well. Since my own depression, I’ve gone on to do better work. You understand human beings in a very different way. You see their ailments, and you do what you can to help.

Robert O. Boorstin is Special Assistant to the President for Policy Coordination, and Communications Director for Health Care Reform. For three years, Boorstin ran support groups for people with manic depression or depression and for their families.

In my view, the CEO should have confronted Dan directly and insisted that he see a doctor immediately. If Dan had had convulsions, the CEO would have sent him to a hospital and had him checked for epilepsy. The difference between depression and other illnesses is that it can lead to suicide. Left untreated, one out of six depressed people attempt to kill themselves.

Still, hospitalization for employees like Dan should be avoided if at all possible. It’s debilitating to a person because of the stigma associated with mental illness. And it’s devastating economically. The costs of hospital stays have escalated to $20,000 or $30,000 per month. Those skyrocketing costs are one of the reasons that President Clinton’s health care reform plan calls for placing people in the least restrictive environment possible.

I would allow Dan to return to his job only if he were on medication and under medical supervision. It might be wise first to bring him in part time and then build up his responsibility level gradually. To dispel any myths about his illness, the CEO should bring in a psychiatrist to talk to employees about depression and manic depression. He could also show videos, such as Down-time: A Worksite Guide to Understanding Clinical Depression, produced by the Depression and Related Affective Disorders Association (DRADA) in Baltimore and the Wellness Councils of America (WELCOA) in Omaha.

I was diagnosed with manic depression in 1987 when I was a reporter for the New York Times. I was terrified, but I was also relieved to know that there was a biological basis for my bizarre moods. At the time, I was about to start working on the Dukakis campaign. I called the person who hired me, told him about my illness, and asked if he still wanted me for the job. His only question was, “Will this be good for you?” Similarly, George Stephanopoulos, a senior adviser to the president, knew about my illness when he hired me to work on the Clinton campaign. We had only one discussion about how manic depression would affect my work, in which I explained that I needed to nap for half an hour to an hour each day.

I think that the stigma surrounding manic depression is lessening because of movies and books that are demystifying the subject. But it’s still dangerous to go public with mental illness in some companies. Manic-depressives have been turned down for promotions because they are seen as unstable; others have been fired from their jobs. Employers can use this knowledge to call an employee’s judgment into question: “That’s just the illness talking.”

Still, I’m hopeful that the 1990s will be for manic depression what the 1980s were for alcoholism. The more people are open about the illness and able to function well in their jobs, the quicker society will accept manic depression. People will finally see that mental illness should not be a hindrance to a successful career.

The more people are open about the illness and able to function well in their jobs, the quicker society will accept manic depression.

Daniel J. Conti is a clinical psychologist and a vice president and Employee Assistance Program director of the First National Bank of Chicago in Illinois.

Less than 50% of people with depressive illness seek treatment, often because they lack the knowledge or fear the stigma associated with mental illness. Interestingly, the stigma is felt most intensely by successful, highly visible individuals who shoulder weighty responsibilities. As a result, the people whose productivity may lead to the greatest common good are often the last to receive psychiatric help.

Dan’s previous level of productivity should provide some solace for the CEO. In most cases of depression and manic depression, people’s level of functioning before a psychiatric episode is indicative of their level of functioning after treatment. Granted, Dan’s behavioral excesses—the long hours and manic energy that had provided some short-term benefit to the business—will be less extreme after treatment with proper medication. But his intellectual capabilities, including his business acumen, will be undiminished. With a new balance in lifestyle, his capabilities may even be enhanced.

Thus, the CEO should stay the course with his illustrious head of strategic planning. In addition to a moral imperative, there is the law to consider: the Americans with Disabilities Act of 1992, which prohibits discrimination against handicapped individuals. Notably, mental illness is included in the definition of handicapped.

The Act requires that an employer make a “reasonable accommodation” for a handicapped employee. In this case, it is likely that Dan may need a few months to adjust fully to the medication and reestablish his daily rhythms. He may need to avoid unusually late hours or early morning meetings. Or he may need special travel arrangements, allowing a buffer day before and after coast-to-coast trips. Given the provision of the Act and Dan’s talent, the CEO should see him through the course of his recovery with reasonable adjustments in his job responsibilities. Should the CEO elect to arrange for Dan’s dismissal, he could face costly and justified litigation.

If the CEO elects to dismiss Dan, he could face costly and justified litigation.

The CEO made a critical mistake: he was so eager to keep the matter private that he decided not to consult the Employee Assistance Program (EAP). At First Chicago, EAP has managed psychiatric short-term disability since 1989. During this period, the average length of a psychiatric disability episode has been substantially reduced, and there has been no increase in the likelihood of a return to disability status. EAP works with the health care provider to coordinate a course of treatment and come up with suitable accommodations during the period of recovery. Most important, EAP recognizes the therapeutic value of work itself, particularly for high-functioning individuals with depressive disorders. As Dan stated, work served as an important coping strategy and was a key element of his identity. To give him a prolonged vacation, with an unstructured daily routine, may delay his rehabilitation and place him at increased risk for relapse. The best place for Dan is on the job.

A version of this article appeared in the May–June 1994 issue of Harvard Business Review.